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Life After Coloanal or Colorectal Anastomosis Surgery

It may be reassuring to know that satisfaction with this procedure has been high. The absence of a permanent ostomy has eliminated the concern of many people about their body image. However, it will take time, patience, and trial and error to adjust to this lifestyle change.

Anal/Pouch Bleeding
In the beginning, don't be afraid if you experience a small amount of bleeding around the anal area. This is normal and is usually caused by irritation at the suture line (your stitches).

Diarrhea
The frequency and consistency of bowel movements varies from patient to patient. Usually the first bowel movement occurs two to three days after the operation. Pressing a pillow against your abdomen can help ease the discomfort, from your incision.

What You Should Do

  • If you had a coloanal anastomosis, it is important that you continue to exercise your anal muscles. Begin this practice after you are discharged from the hospital. The stronger the muscle, the better control you will have.
  • Call your doctor if you have more than six stools a day. He or she will prescribe medication to help decrease the diarrhea and increase the bulk.
  • Thin or watery stools are difficult to hold. Bulking agents, (i.e., Citrucel) antidiarrheal medicines (i.e., Imodium, Lomotil) and change in diet—eating foods such as rice, that bind the bowel movements can often resolve this.
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Incontinence
If you had a coloanal anastomosis, it is normal to have some incontinence and/or leakage—most frequently at night. It may be reassuring to know that over time, this will resolve.

Minor nighttime incontinence is the most common, and you should be prepared for this. The leakage will improve as the anal muscle strengthens. If you need added protection, pressed cotton makeup removal pads are the most absorbent. Place one of these in front of the anal area. Be sure to change the pad each time you urinate or have a bowel movement.

You may find that is difficult to tell the difference between gas and stool. This can be a frustrating experience. Be patient with yourself, you will gradually learn to tell the difference again.

Remember: It is common for it to take about six months to be able to tell the difference between gas and stool.

Irregularity
Irregularity, while bothersome, is common after this surgery. You may experience what's known as an "all or nothing" pattern of irregularity for about 8 to 12 weeks following surgery. This is because the colon that is connected to the lower rectum or anal muscles has not yet had a chance to stretch.

It is not unusual to have very frequent bowel movements one day and then none the next day. Do not be alarmed if it takes several hours to empty your bowels with multiple small bowel movements—this is normal.

This phase will pass. After surgery, it is important to use Citrucel (or other fiber products) and antidiarrheal medicines (i.e., Imodium, Lomotil) to adjust bowel frequency so that you have 2 - 4 bowel movements every day and avoid the "all or none" pattern. This will help the colon stretch more quickly so that your bowel movements become regulated.

Skin Care
It is very important to keep the anal area free from irritation and itching. An irritated anal area is more likely to send confusing signals and trigger more incontinence.

What You Should Do

  • Examine your skin and notify your surgeon's office if you see any rashes.
  • Do not wipe the anal area with harsh toilet paper. Use baby wipes instead, which are more suited for delicate skin.
  • Be sure to rinse the anal area with warm water and pat dry.
  • Wearing cotton underwear will allow air to get to the area so that your skin will not get too moist.
  • Your surgeon may recommend some soothing ointments. There are many products that might be helpful, (i.e., Calmoseptine or Criticaid).

Remember: Continue to follow this skin care routine for two to three months after surgery—when the number of bowel movements decreases.

Long Term Concerns
If you had a precancerous condition or had cancer, follow-up is very important. You should ask what the recommended follow-up is in your situation. Most often, your physician will recommend the following:

  • Blood Work: CBC (complete blood cell counts), CMP (a group of blood tests that measures kidney and liver function, as well as the level of protein in your blood), and CEA (a marker for colorectal cancer or recurrent colorectal cancer) every three months for the first three years. Then every six months the next two years, then annually thereafter.
  • Chest X-ray: Every six months for the first two years, then annually thereafter.
  • Colonoscopy: One year after surgery, then every two years thereafter if polyps are found.

Everyone who has had this procedure should be sure to carefully follow the advice your surgeon and nurse have given you. Don't be shy to ask for help when you need it. Enlist the support of family, friends, and qualified members of your healthcare team.

Remember: Motivation, determination, and regular follow-up screening are key to help ensuring the best surgical outcome.

For any questions about your surgery or your follow-up, it is always best to contact your physician.

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